A Three-Year Follow-up of Lumbar Spine Endplate (Modic) Changes

Mari Kuisma, MD; Jaro Karppinen, MD, DMSc; Jaakko Niinimäki, MD; Mauno Kurunlahti, MD, DMSc; Marianne Haapea, MSc; Heikki Vanharanta, MD, DMSc; Osmo Tervonen, MD, DMSc

Disclosures

Spine. 2006;31(15):1714-1718. 

In This Article

Abstract and Introduction

Study Design: A longitudinal follow-up of Modic changes on magnetic resonance imaging (MRI).
Objectives: To assess the prevalence and natural course Modic changes over a 3-year follow-up period.
Summary of Background Data: Modic changes are bone marrow and endplate lesions visible on MRI. To the authors' knowledge, no follow-up studies on their natural course have been published.
Methods: The study population consisted of 60 unoperated sciatica patients 23 to 76 years of age. Baseline and 3-year lumbar MR images from L1-L2 through L5-S1 were analyzed independently by 2 radiologists and a consensus reading was performed.
Results: At baseline, the prevalence of Modic changes was 23%. Seven discs had mixed Type I/II, and 63 Type II change. Changes typically occurred at L4-L5 and L5-S1, and associated positively with age (P = 0.009). Ten of 70 discs (14%) with Modic changes at baseline displayed another type at 3 years. Furthermore, the nonconverted changes increased significantly in size. The incidence of new Modic changes during the follow-up was 6% (13 of 230).
Conclusions: Modic changes are common MRI findings in patients with degenerative lumbar disc disease. We found evidence that Modic Type II changes may be less stable than previously assumed.

Modic changes are bone marrow and endplate lesions visible in magnetic resonance imaging (MRI). They were first described in the 1980s with a prevalence affecting 22% to 50% of discs in patients with degenerative intervertebral disc disease.[1,2] Modic Type I lesions, hypointense in T1-weighted sequences and hyperintense in T2-weighted sequences, are assumed to indicate an ongoing active degenerative process. Type II lesions, hyperintense both in T1- and T2-weighted sequences, are thought to manifest a more stable and chronic process reflecting fatty degeneration of the bone marrow.[2] Type III lesions, hypointense both in T1- and T2-weighted sequences, are thought to correlate with subchondral bone sclerosis.[3]

Mixed Modic lesions (Type I/II and Type II/III) have also been identified. Braithwaite et al suggested that Modic changes can convert from one type to another and that they all present different stages of the same pathologic process.[4] Modic et al showed that Type I changes commonly progress to Type II changes, but they can also revert back to normal.[2] Furthermore, they observed that Type II changes usually do not alter with time. Apart from the study of Modic et al,[2] no studies on the natural course of Modic changes have been undertaken. The purpose of this prospective study was to assess the prevalence, extent, and natural course of Modic changes over a 3-year follow-up period.

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